Michael Moline, Author at Florida Politics - Page 6 of 53

Michael Moline

Michael Moline is a former assistant managing editor of The National Law Journal and managing editor of the San Francisco Daily Journal. Previously, he reported on politics and the courts in Tallahassee for United Press International. He is a graduate of Florida State University, where he served as editor of the Florida Flambeau. His family’s roots in Jackson County date back many generations.

New lawsuit highlights legislative logjam over PIP reform

Florida’s no-fault insurance system continues to generate fraud, judging by allegations in a lawsuit that insurer State Farm filed in federal court.

The suit, filed in the Southern District of Florida on Aug. 1, alleges three clinics cheated it out of $4.7 million.

Will suits like these help break the policy logjam that has prevented the Legislature from responding to problems with the state law requiring motorists to carry personal-injury protection (PIP) policies?

Not necessarily, according to Sen. Tom Lee. The Thonotosassa Republican’s PIP repeal bill died in committee last Session. That was amid wrangling with the House over whether to mandate that drivers carry at least $5,000 in medical coverage.

“The problem has to become more painful than the solution for consensus to develop in the Legislature,” Lee said in a telephone interview. “It was clear last year that we just weren’t there yet.”

Like Lee, Rep. Erin Grall, the Vero Beach Republican who carried the House PIP bill, declined to comment on the merits of the case.

“Having worked on legislation that would have repealed the PIP statute, I heard many stories about fraud and abuse,” she said in a statement to Florida Politics. “Whether the allegations in the State Farm complaint amount to fraud is a matter for the courts … (and) a jury of Floridians that have given the facts careful consideration.

“While I believe moving to a fault-based system of auto insurance will naturally eliminate or thoroughly reduce fraud, the overwhelming majority of health care providers in this state operate with professionalism and integrity and this suit shouldn’t be a standalone indicator of all providers’ treatment of the system,” she said.

The complaint alleges that three clinics — Health & Wellness Services Inc., Medical Wellness Services Inc., and the Pain Relief Clinic of Homestead, controlled principally by Beatriz Muse and her brother, Lazaro Muse, both of Miami — “orchestrated a scheme to defraud” State Farm. Beatriz Muse’s husband, Noel Santos, also is named.

The 59-page complaint alleges fraud, deceptive and unfair trade practices, and unjust enrichment. The clinics submitted “false, materially misleading, and/or fraudulent bills and supporting records to plaintiffs for services which were not medically necessary, and in some instances were never actually rendered,” State Farm says.

According to the complaint, the clinics administered a “predetermined treatment plan” regardless of the patients’ injuries. They failed to adequately examine patients to learn the true nature and extent of their injuries; diagnosed nearly every one with “non-specific pain/sprain/strains of the cervical, thoracic, and lumbar regions of the spine regardless of their true condition;” and treated nearly every one with “excessive therapy modalities regardless of the unique circumstances and needs of each patient.”

Nearly every patient got an X-ray scan, but the results weren’t used in the treatment plan. Patients were re-evaluated “to further the predetermined treatment plan rather than as part of individualized care.” Finally, the clinics submitted documents to State Farm falsely representing that these treatments were medically necessary.

“As a result of the predetermined treatment plan at the Muse clinics, insureds were not properly examined, diagnosed, or treated for conditions which they might have had; insureds were subject to medically unnecessary and sometimes excessive medical treatments; and insureds’ limited no-fault benefits were substantially depleted or exhausted, and therefore not available for appropriate treatment what the insureds may have needed.”

The complaint also alleges irregularities involving five doctors listed as the clinics’ medical directors and failure to ensure that clinic staff were properly licensed, and that the defendants appointed third-parties as clinic owners on paper to disguise their control of the businesses.

The scheme, the complaint alleges, extended back as far as 2007. A complaint in a lawsuit tells one side of a story; the defendants have not yet filed an answer, dockets show. Moreover, U.S. District Judge Robert N. Scola Jr. last week questioned whether the federal courts have jurisdiction, requiring an amended complaint from State Farm by Friday.

Meanwhile, in the Legislature, PIP repeal is likely to come up again, as are efforts to address assignment of benefits abuse and the workers’ compensation system. The Legislature has struggled for years to agree on approaches to those issues.

Lee

Here’s Lee’s diagnosis: “It all got caught up in the same dynamic of special interest groups battling it out over just what constitutes real reform. It all just went down in flames.”

He blames the insurance lobby for trying to “inject” language making it harder for policyholders to sue carriers for bad-faith in denying or delaying their claims. Plaintiffs who establish bad faith can recover far in excess of the amounts provided in their policies, as an incentive to good behavior by carriers.

“There’s probably some room for bad-faith reform, but often what is presented by the insurance companies amounts to bad-faith immunity, not reform,” Lee said.

“Without entirely rewriting insurance policies to alleviate the insurance companies of the traditional duty that they have to defend the insured, and to stand in and provide their expertise in helping the insured manage through a liability, you can’t pass the kind of bad-faith reform the insurance industry has been proffering,” he said.

“These are really complex issues. I’ve been working on them since the conference committee on the medical malpractice bills during those special sessions that took place in 2003. Bad-faith was a major issue. It’s just difficult to write statutes that don’t give one side or the other a tremendous amount of leverage to force a settlement.”

Toward the end of the session, Lee suggested to House Speaker Richard Corcoran settling for a hybrid bill.

“If you like your PIP, you can keep your PIP,” he said. “But everybody who’s willing to move to a mandatory bodily injury (BI) policy can drop their PIP. That would have been a substantial savings for a lot of people.” Around 10 percent of the driving population carry PIP only, Lee said.

Tom Lee says he’s looking forward to leadership change in Senate

Tom Lee is psyching himself up for another term in the Florida Senate.

“I was pretty much resolved to step away for a little while, and get on with some business and try to help my son get through high school,” the Thonotosassa Republican (and Senate President in 2004-06) said last week.

After considering runs for Chief Financial Officer and for Congress, and even leaving politics altogether, he decided last month to seek re-election.

He faces John Manners Houman in this month’s Senate District 20 primary. Joy Gibson and Kathy Lewis are vying to be the Democratic nominee.

Lee, who has served a combined 16 years in the chamber, clashed regularly with leadership under President Joe Negron of Stuart, but expects better days when Bradenton Republican Bill Galvano wields the gavel, as expected next year.

“My sense is there are going to be a lot of changes in the Senate, and it’s going to be a more rewarding place in which to serve in the coming years,” Lee said.

Then there’s the good of the party to think about.

“It’s much easier to recruit for the other party if you’re not running against an incumbent — depending on the incumbent, I guess,” he said.

“In this case, I think it would have been much easier for the Democrats to recruit candidates. And there’s no question about it — there would have been a Republican primary, and that would have cost a substantial amount of resources.

“Resources are finite. If those resources could be saved and utilized in other races where we have thin margins for error, it can help people sleep a little better at night.”

Ethics Commission finds evidence lobbyists filed inaccurate disclosure reports

The Florida Commission on Ethics has found probable cause that five lobbying firms filed inaccurate financial disclosure reports for 2016. The evidence turned up in random audits of executive branch lobbying firms, the commission said Thursday.

The panel cited evidence that Andrew J. Liles filed an inaccurate compensation report during all four quarters of 2016. State records list his existing clients as the Florida Wildlife Federation and the Seaside Institute.

Lester Abberger, listed as lobbying under his own name and for Florida Lobby Associates Inc., reported compensation from two clients for which his firm was not registered during all four quarters of 2016, the commission found. Additionally, the commission found evidence of incorrect compensation reports from two principals during that year’s first quarter.

Abberger said he had neglected to delist two former clients and reported zero dollars in compensation from them for the year. “I complied completely with the spirit and intent of the requirement, but didn’t realize that I had to take those clients off my list,” he  said.

Pruitt & Associates was cited for what the commission called inaccurate compensation reports for all four quarters of 2016. Registration records for that year listed Kimberli Anne Pruitt of Lady Lake as a lobbyist for A Child is Missing. She is not listed in current lobbyist records.

Pruitt confirmed she had been registered to lobby but had no further comment. Her husband, Will Pruitt, a former lobbyist, said the client was the small nonprofit behind the Amber Alert system. It paid his wife’s fees two years late, he said, and she was unsure how to report that on the disclosure form. “I think it was a couple of hundred bucks,” he said.

Also cited was Wilson & Associates LLC, accused of properly identifying its principal during each quarter of 2016 and overstating and understating compensation. The firm’s website lists Rob Wilson as president.

Finally, the commission found probable cause that TC Wolfe filed inaccurate financial reports during three quarters of 2016. State records show that Terrence Wolfe is no longer registered to lobby in Tallahassee. A website for New Century Government Affairs indicates he is affiliated with that firm, which maintains offices in Miami and Washington, D.C.

None of the others listed have responded thus far to requests for comment.

Florida ranks high in workers’ comp legislation, survey shows

A new law extending mental health treatment to firefighters, police officers, and other first responders with PTSD ranked Florida among the bellwether states in a survey of trends published by a national workers’ compensation ratings agency.

The Regulatory and Legislative Trends Report, compiled by the National Council on Compensation Insurance, or NCCI, cites SB 376, signed into law in March by Gov. Rick Scott.

The legislation, initially opposed by the Florida League of Cities, cleared both legislative chambers unanimously.

The only other state to pass such a law was Washington. New Hampshire established a commission to study the topic. Arizona, Kentucky, Minnesota, Missouri, Ohio, South Carolina, and West Virginia debated but did not approve similar measures.

The Florida bill was a priority for Chief Financial Officer Jimmy Patronis, who also serves as state fire marshal.

“PTSD is a hidden killer among our first responders,” he said at the time. “It’s critical that we do everything possible to ensure first responders are not alone as they cope with the horrific images they see daily. Today was not only a day to honor those we have lost, but to celebrate the lives we could save.”

The bill takes effect Oct. 1. Under existing law, first responders must suffer a physical injury to qualify for PTSD care.

Also featuring in the survey is HB 7087, tax legislation passed within 45 minutes of adjournment, which includes language establishing that “marketplace contractors” are not eligible for workers’ compensation coverage.

The term encompasses drivers, household workers, and others who connect with customers via apps like Uber, Lyft, or Handy.

Indiana, Iowa, Kentucky, and Tennessee passed similar laws; Alabama, California, Colorado, and Georgia debated but did not approve them.

NCCI has also been monitoring legislation controlling use of prescription drugs for workers’ compensation claimants; single-payer health care (legislation passed the California Senate and is awaiting action in the Assembly, but has languished in Florida); and marijuana legalization (nine states and the District of Columbia have legalized recreational use; only Idaho, Kansas, and Nebraska have not legalized marijuana in some form).

In other findings, Kentucky was the only Southeastern state to enact “significant” workers’ compensation reforms this year. Florida has debated legislation intended to make it harder to challenge workers’ compensation awards in trial courts and boosting oversight of contractors for two years but the House and Senate have been unable to agree.

NCCI is an information clearinghouse for workers’ compensation insurers and proposes premium levels in many states, including Florida.

Florida’s property tax outlook: ‘No bad news coming’

Property tax revenues will remain stable during the next few years, according to state economic forecasters — meaning no big surprises there when the Legislature gets to work on the next state budget.

The Florida Revenue Estimating Conference met Tuesday morning to review trends in “ad valorem” tax receipts. Final numbers were expected later in the day.

“We went through all the components in the forecast, and even though some of them shifted a little bit, the result’s going to be pretty much similar to what we forecast back in January,” said Amy Baker, coordinator for the Office of Economic and Demographic Research.

“In terms of legislative expectations, there’s not big changes coming out of today,” she said. “At least for ad valorem, there’s no bad news coming.”

The panel concentrated on “a lot of little adjustments,” Baker said.

“Population growth continues to feed in. We’re not seeing any big changes in terms of our expectations on home ownership rates. We’re not seeing big adjustments in any of the categories. It was really fine-tuning today of everything.”

As for home ownership, its rate continues to lag behind the historical trend of more than 66 percent, following the Great Recession and housing market collapse. It’s running about 64 percent.

“We’re not seeing that break loose yet,” Baker said. “It was slightly lower than the year before. We fed that view through the forecast today — that we aren’t going to see a massive switch in the near term.”

Baker doesn’t expect massive increases in rents, given that the supply of rental properties remains stable, as homes previously occupied by owners have entered the rental market.

The trend will depress collections of the documentary tax on property transfers, she said. The conference’s forecasts of school tax receipts were off by only 0.2 percent.

“We’ve got real good faith that we’re hitting the right statewide number. What we continue to wrestle with is how to make sure our county-by-county estimates are even tighter than they are.

That matters for legislative expectations of what they’re doing with the distributions of the FEFP,” referring to the state contribution to fund local schools, Baker said.

“Now that we’ve got a good track record of getting the statewide number correct, it’s time to turn our attention to getting the distribution between counties a little better than what it’s been.”

Appeal court sides with Rick Scott in dispute over filling Nassau County judgeship

A state appellate court, for the second time in four years, has upheld Gov. Rick Scott’s authority to fill a judicial seat left vacant when a judge resigned before qualifying opened to fill the slot via election.

The 1st District Court of Appeal had ruled in the same way against the same appellant, Jacksonville attorney David Trotti, the last time. This time, a three-judge panel overturned Leon County Circuit Judge Charles Dodson, who’d issued a temporary order blocking Scott from replacing Judge Robert Foster of Nassau County.

Judge Clayton Roberts, writing for judges Timothy Osterhaus and Adrian Wetherell, cited “neutral principles (that) will apply no matter who the Governor is or what the current political climate looks like.” Ruling otherwise, the court said, citing it’s earlier ruling, “would be nullifying the governor’s power of appointment” under the Florida Constitution.

A divided Florida Supreme Court earlier this week reinstated Dodson’s injunction against Scott, without comment. And his attorneys pointed to nonbinding opinions by four Supreme Court judges in 2016 supporting his position.

But the higher court has yet to formally overturn the 1st DCA’s position on the subject, Roberts wrote. “Therefore, it is still binding precedent, and the circuit court was obligated to follow it.”

Trotti’s legal team tried to argue around the court’s last ruling by arguing that Foster had approached mandatory retirement age, and that his would, therefore, be “a known vacancy” waiting to be filled via election — and that his “motives in tendering a letter of resignation when he faced mandatory retirement were a flagrant disregard of the election process.”

The 1st DCA panel didn’t bite. “As we stated in Trotti I, we decline to engage in an analysis of subjective factors such as unreasonableness of an impending vacancy or, in this case, Judge Foster’s motivation to resign,” Roberts wrote.

“Under Mr. Trotti’s logic, and the logic of the dissent in Trotti I, a reviewing court would have to analyze a resigning judge’s subjective intent in the hopes of determining whether the resignation was a matter of political gamesmanship. Is resigning with five days left in a term gamesmanship? What about two weeks? Or two months?

“And what about the judge’s motivation to resign? Should it matter if the vacancy was created because the judge wanted to create a vacancy filled by appointment? What if a vacancy occurred because the judge was going on a cruise or elected to have a medical procedure? Such an analysis of subjective factors poses a slippery slope that, in our opinion, is avoidable under the plain language of the Florida Constitution and the case-law interpreting it.”

The court rejected arguments that allowing the appointment would deprive the voters of an election, noting that would leave Trotti the only candidate on the ballot. “Mr. Trotti’s proposed remedy would still disenfranchise the voters,” Roberts wrote.

State’s self-insurance fund projected to run low again next year

State government’s self-insurance fund faces a $14 million shortfall during the 2019-2020 fiscal year, driven in part by the cost of repairing Hurricane Irma’s damage to state property and medical inflation.

Florida’s Revenue Estimating Conference, comprising top state economists, arrived at the figure Monday.

”The Legislature’s going to have to address that,” said Amy Baker, who runs the Office of Economic and Demographic Research and chairs the estimating conference.

It would be the second deficit in a row for the Risk Management Trust Fund. The Legislature plugged a $20 million hole during its last session.

Baker blamed the cost of litigating and settling civil rights class actions against the state, medical expenses including rising pharmaceutical prices, and lingering Irma repairs.

”The trust fund kind of gets hit with all the same kind of things the other agencies do,” she said.

One area where the state lagged was workers’ compensation, where indemnity and medical expenses combined ran at $119.6 million during the last fiscal year, which ended June 30. That was $2.4 million higher than originally estimated.

”All of that is in the medical,” Baker said. “Medical was actually $3.3 million higher, but workers’ comp indemnity was $900,000 lower.”

The trend exists governmentwide — “drugs in particular,” she said.

”We’re seeing it in Medicaid. We’re hearing about it in kid care. We hear about it in Corrections. It’s pervasive.”

Panel sends Rick Scott six finalists for PSC vacancies

A state panel declined Tuesday to choose among six candidates for the Public Service Commission, and instead voted unanimously to send all six names to Gov. Rick Scott.

The candidates include Julie I. Brown and Gary Clark, incumbent commissioners whose terms expire at the end of the year. The Florida Constitution forbids commissioners from serving more than three four-year terms.

“I would like to suggest, for efficiency, that we can just submit them as a slate, with one vote,” said Sen. Kelli Stargel, chairwoman of the PSC Nominating Council, during a televised hearing in Orlando.

First, the candidates had opportunities to pitch their qualifications during a joint job interview. The job pays more than $130,000 per year.

Brown is a former PSC chairwoman first appointed to the commission by Charlie Crist and reappointed by Rick Scott. She emphasized the PSC’s efforts during her tenure to adjust to technical advances in the energy sector, including the rise of electric vehicles and energy storage technology.

During her time as chairwoman, she said, the panel emphasized grid resiliency and engagement with utility customers. Florida is a leader in the regulatory sector, she said.

“States are modeling it after Florida,” Brown said.

One major challenge in the future is protecting the “smart grid” against cyber incursions and natural disasters, she continued. “Storm hardening” has been a priority for the PSC for 10 years.

“The challenge is for utilities to continue to stay vigilant and continue to develop technologies that can prohibit penetration of the grid,” Brown said. 

Clark has served since September 15, 2017, appointed by Scott to the vacancy left when Jimmy Patronis departed to become the state’s chief financial officer. He has served as administrator of Florida’s state parks system and as an executive with West Florida Electric.

His continued service would bring continuity and predictability to the commission, he said.

Asked about the commission’s workforce, Clark suggested expansion to might be in order to cope with increasingly sophisticated utilities networks. “We’re probably going to have a larger amount of technical staff at some point,” he said.

Anibal Taboas is an executive consultant with Strategic Leadership and Risk Management, a consultancy in the Chicago area, where he has advised corporations and educational and governmental institutions, including the U.S. Department of Energy, on best practices.

The Puerto Rico native serves as president and CEO of Aspira Inc. of Illinois, which operates charter schools and a youth development center.

Taboas emphasized the opportunity to pursue social responsibility, including encouragement of autonomous vehicles as a way to solve traffic congestion, and preparedness for cyber attacks and natural disasters.

Although he lives out of state, Taboas said, he has family ties to Florida and understands its regulatory challenges. Including, he said, the threat from climate change and rising sea levels to utilities infrastructure.

“I intend to be ready,” Taboas said. ”There’s value to having another set of eyes, another way of thinking.”

Amir Liberman, of West Palm Beach, operates Consulting.Net and has provided software consulting services for Florida Power & Light Co. The native Israeli conceded his lack of background in regulatory affairs, but highlighted his experience in the energy sector.

As a rural resident — Liberman operates a honeybee farm — he called for better cellular and internet service to areas like his own.

Regarding his ties to FPL, “all of my obligations are either expiring or will expire” by the time be would take office, Liberman said.

Monica Rutkowski is a regulatory and compliance consultant in Tallahassee specializing in health care and insurance, and has served at a high level in the Florida Office of Insurance Regulation. She is president of MER/Risk and Regulatory Compliance Solutions.

She has found that the same regulatory considerations she has dealt with during her career apply to the PSC, Rutkowski said, including balancing the needs of consumers with utilities and other stakeholders.

“There’s never a downtime,” she said. Regulator and regulated industries alike are always adjusting to risk. “You have to stay on top.”

Gregory Hill is a senior attorney for the Florida Department of Corrections. Previously, he served in the military, as a police officer in Tampa, as a public defender, and as counsel for children’s legal services in the Office of Attorney General.

Hill, a member of the Six Nations of Indians in New York state, never has worked for the utilities industry of any consumer group, he said, and would bring impartiality to the job. At the same time, he appreciates that “Florida has a very diverse utility climate.”

He is up to the steep learning curve he will face, Hill said. He’s adapted quickly on his feet before, mastering DNA and digital evidence standards as a criminal-law attorney.

Study projects rising medical inflation through next year

An insurance industry analysis projects medical inflation of more than 2 percent through the end of 2019, chiefly because of improved treatment quantity driven by hospital consolidation.

What that means for Florida’s workers’ compensation system remains unclear, according to a briefing paper, “The Impact of Hospital Consolidation on Medical Costs,” published by the National Council on Compensation Insurance, or NCCI.

The organization, which in Florida proposes workers’ compensation insurance premium levels to state regulators, plans additional study into that question.

“Impacts of hospital concentration have been estimated for commercial health insurance and Medicare, which can help explain the effect on workers compensation even though the types of care are different,” the document says.

“It is likely that the price of inpatient services for workers compensation is higher in highly concentrated markets and, like Medicare, that higher quantities of medical services are provided.”

Medical inflation ran at 1.4 percent in 2017.

The briefing paper attributes the trend to “a second wave” of hospital consolidation beginning around 2010. The field experience 55 deals on average between 2002 and 2009, increasing to 93 by 2011. By 2017, the number has increased to 115, and thus far in 2018 to 30.

Hospital concentration increases prices paid by commercial insurers, the paper says, at rates ranging from a high of 40 percent to a low of 6 percent, depending on methodology.

“Advocates of hospital mergers, particularly the merging hospitals themselves, emphasize efficiency and scale advantages such as those described above,” the paper says.

“However, research to date on completed hospital mergers has yet to demonstrate the benefits of consolidation via improved quality, access, and cost.

“Mergers increase the likelihood of intensive surgery and total number of surgeries, but do not improve patient outcomes. Mergers have also been found to reduce hospital costs per risk-adjusted discharge, but not to reduce the price of hospital care to insurers.”

Under Medicare, hospital concentration increases costs by boosting the quantity of care delivered, the document says.

In concentrated markets, patients are more likely to be discharged to a post-acute facility instead of home, and to undergo inpatient rather than outpatient surgery.

However, Medicare patients in less concentrated markets receive fewer services.

“This result is not surprising, since more concentrated hospital systems have a greater ability to provide intensive high-fee services in-house, rather than referring them out,” the paper says.

Jimmy Patronis warns of electric car fires

Firefighters need training to quench fires caused by lithium ion batteries in electric cars, Chief Financial Officer and State Fire Marshal Jimmy Patronis said Thursday — especially since they’ve been known to re-ignite, sometime more than once.

“New technology helps us live our lives more efficiently, but that doesn’t mean we shouldn’t understand and tackle the risks that can be associated,” Patronis said in a statement.

“In 2017, there were more than 16,000 electric vehicles registered in Florida and more than 321,000 electric/gas hybrids. Our fire departments around the state should be equipped with the latest information on how to best manage electric vehicle fires so that they can do their job safely and effectively,” he said.

Patronis told his staff to offer specialized training to rank-and-file firefighters in putting out these fires.

Electric cars are no more prone to burning than gasoline models, but require special treatment, he said.

For example, a Tesla that crashed in Fort Lauderdale in May required between 200 and 300 gallons of water plus foam to put out, and even then broken pieces of the battery reignited — once when loaded on a truck for removal, and again in the storage yard, Patronis said, citing a National Traffic Safety Board report.

The first thing is to identify the make and model, to know where the battery is located and the best way to shut down the vehicle. Stored energy in different battery compartments are liable to ignite independently.

Patronis advised keeping wrecks away from built structures, and bearing in mind that electric vehicles are silent and may be “on” when they don’t seem so, and present a shock hazard.

Finally, he advised wearing self-contained breathing apparatuses when fighting electric vehicle fires, for protection against toxic vapors.

“It’s important that firefighters and fire service professionals are aware of the following potentially life-saving practices when dealing with electric vehicle fires.”

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